à The National Cancer Institute (NCI), one of the National Institutes of Health is the largest single provider of funds for cancer research ($2.4 billion in FY 1997).

  • AHCPR estimated it spent $3.9 million for research on health costs, quality, and outcomes related to cancer (out of a research budget of $95 million).
  • HCFA spends enormous amounts on cancer—$16.7 billion in FY 1997—mostly on medical services and care, but it has a small program of research (see below)·
  • CDC estimated that it spent $185 million on cancer-related programs in FY 1997. The categories included breast and cervical cancer ($139.7 million), cancer registries ($22.3 million), other chronic diseases ($8.1 million), infectious diseases ($450,000), environmental health ($1.7 million), and occupational safety and health ($12.7 million). All categories do not represent research programs For example, the breast and cervical cancer program is an early detection program aimed at underserved populations. Deleting this program and assuming the rest of the activities are research would leave $45.3 million.
National Institutes of Health

National Cancer Institute. Cancer Surveillance Research Program. Many of NCI's health services research activities are housed in the Division of Cancer Control and Population Sciences, Cancer Surveillance Research Program (CSRP). CSRP develops information systems and methods needed to conduct cancer surveillance research and makes these resources available to investigators throughout the research community. The linked Medicare-SEER (Surveillance, Epidemiology, and End Results) database, for example, is now widely used to answer cancer-related health services research questions (www.dccps.ims.nci.nih.gov/ARB/SEERMedicare). CSRP-sponsored research evaluates trends in cancer related to risk factors, health behaviors, and health services and assesses the influence of these factors on cancer burden (e.g., cancer incidence, morbidity, mortality, survival)· The division sponsors research related to patterns of care, diffusion of new technologies, cost of cancer care, and methodology and modeling.

Examples of health services research supported by the division include the following (Edwards, 1998a, b):

  • Patterns of Care studies: SEER data are used to describe the dissemination of state-of-the-art cancer treatment and explanatory factors for variation in patterns of care. First conducted in 1987, samples of cases from SEER were obtained in 1988, 1989, 1990, 1991, 1995, and 1996. Currently, data are being collected on cases diagnosed in 1997 with cancer of the head and neck, cervix, childhood brain stem, and ductal carcinoma in situ of the breast. In previous years, cancer sites assessed have included: in situ and early-stage breast, colorectal, ovarian, urinary bladder, melanoma, non-small-cell lung, and childhood cancers. Annual budgets for the past three funding years ranged from $575,000 to $690,000 per year.
  • Prostate cancer outcomes study: A longitudinal survey of 3,500 men with prostate cancer is underway regarding quality of life measured at 6 and 12 months and at 5 years following diagnosis (data collection to be completed in 1999). Practice patterns are also being assessed.
  • Breast Cancer Surveillance Consortium (a national mammography screening and outcomes database): The performance of mammography screenings (i.e., its sensitivity, specific-


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